Behavioral Health

Joint Medicaid Oversight Committee:
Behavioral Health Redesign Beta Testing Part II

By Loren Anthes,
Public Policy Fellow, Center for Medicaid Policy 

November 16, 2017

On November 16, the Joint Medicaid Oversight Committee (JMOC) met to revisit the topic of beta testing Ohio's Behavioral Health Redesign. This time, in addition to a presentation by Medicaid Director Barbara Sears and other Kasich administration staff, JMOC heard from the Ohio Association of Health Plans (OAHP), The Ohio Council of Behavioral Health & Family Services Providers (which represents about 150 behavioral health providers), as well as a few providers themselves.

As Director Sears explained, beta testing has commenced for 179 of the 437 agencies impacted by redesign (about 41 percent), 98 percent of tested fee for service claims are being properly processed, and they have had similar success with MyCare plans, including achievement of network adequacy. OAHP, which represented Managed Care Organizations (MCOs), advanced a similar narrative, describing their efforts to close gaps in service, work on contracting with providers, and provide resources to educate and enhance providers understanding of the new system. The testifying providers, on the other hand, had a greater range of opinions on the progress of Redesign.

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Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing

By Loren Anthes
Public Policy Fellow, Center for Medicaid Policy 

October 23, 2017

On October 19, the Joint Medicaid Oversight Committee (JMOC) met to continue the conversation regarding the progress of Ohio’s Behavioral Health Redesign. In the presentation offered by the state before next week’s commencement of beta testing for claims, the state outlined metrics they have will be using to document their progress including number of patients covered by sign-ups, number of providers enrolled, number of successfully submitted claims (varied by plan), credentialing of providers, and contracted entities. This data is being tracked by the state and was offered to the committee via example screenshots of the Ohio Medicaid and Mental Health & Addiction Departments’ dashboard that can also break down each of these data points by county and zip code. It’s also worthwhile to point out that 37 hospitals have indicated they will start submitting claims for outpatient behavioral health, 13 are already doing so. Previously, law required the majority of these services to be delivered on the community level, so this represents a new layer of capacity for the delivery system that had not previously existed.

The majority of questions from JMOC members centered on the readiness of the state to implement the new system of claims submission. While Ohio Revised Code outlined the expectations of beta testing to the administration, the threshold of what constitutes a “clean claim” (i.e. a claim submitted without any problems) was not defined as a percentage of total testing or the associated scenarios through which that testing is taking place. Senators Tavares and Burke built upon this observation, noting that the future carve-in of these benefits into managed care represents a complicating factor in determining the level of success of claims processing as the system moves away from direct governmental billing in fee for service.

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Joint Medicaid Oversight Committee: Medicaid Budgeting and the Behavioral Health Redesign
By Loren Anthes, Fellow, Center for Medicaid Policy

Adam White, Graduate Assistant
September 27, 2017

On September 21, the Joint Medicaid Oversight Committee (JMOC) met to discuss the state budget process and the Behavioral Health Redesign and, on September 22, the state convened one of its regional forums on the redesign for providers. These two events can demonstrate how policy is discussed in the context of committee and the practical effects these discussions may have on the behavioral health system.

In JMOC, Directors Barbara Sears and Tracy Plouck presented on the Medicaid budget and the behavioral health redesign. To frame the conversation, the administration presented its current biennial funding scheme as a “gap,” citing the lack of policy tools authorized by the General Assembly in the most recent budget process. As they explained, cuts to hospital rates and adjustments to hospital supplemental payments and managed care were necessary to achieving budget neutrality in the appropriation expectations set by the legislature. This framework was not well-received by members of JMOC who made claims that the acceptance of the budget by the governor may be unconstitutional, that efforts to control costs could be made at the expense of providers and the clients they serve, and that the Ohio Department of Medicaid did not have the adequate legal authority to change payment rates. Specifically in regard to redesign, several members voiced concerns that the current budgeting proposal, and the redesign itself, could cause complications in the delivery of care for individuals with mental illness or substance use issues.

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JMOC Hears Testimony from ODM, ODMHAS, and Behavioral Health Providers as Redesign Implementation is Delayed
By Adam White
Graduate Assistant
June 29, 2017  

After over two years of preparing to carve new behavioral health benefits into Medicaid managed care plans and recode all Medicaid behavioral health services to align with national coding standards, the Ohio Departments of Medicaid (ODM) and Mental Health and Addiction Services (ODMHAS) had announced they were ready to go live with the Behavioral Health Redesign starting on July 1, 2017. The agencies filed rules implementing the changes with the Joint Committee on Agency Rule Review (JCARR) earlier this spring after the Common Sense Initiative Office ruled the rules would not have an adverse impact on business. However, after hearing from numerous small providers that were unprepared to go forward with the new system on July 1, the Ohio House of Representatives inserted a provision in the budget bill (H.B. 49) that would prohibit the new system from going live until January 1, 2018, and further delay the carve-in of alcohol, drug addiction, and other mental health services into Medicaid managed care until July 1, 2018. Correspondingly, JCARR requested that the administration place its proposed rules in “To Be Refiled” status to allow for further review.

On Thursday, June 22, the Joint Medicaid Oversight Committee (JMOC) of the Ohio General Assembly heard testimony regarding the status of the Behavioral Health Redesign from ODM Director Barbara Sears, ODMHAS Director Tracy Plouck, and representatives from various behavioral health providers. Directors Sears and Plouck testified that the administration is respectful of the budget deliberation process and that the agencies will not refile rules affecting community mental health providers nor propose an effective date for the rules until the budget process has concluded. However, Director Sears affirmed that the hospitals are prepared to move forward with the coding changes and make the new services available as soon as possible. Therefore, ODM has refiled a rule to increase access to services for children and multi-system youth with an effective date of August 1, 2017. Director Sears noted that ODM is able to accommodate these new services sooner because the billing methodology for hospitals in the Medicaid claims system is separate from the coding changes relating to community providers.

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House-Passed Version of State Budget Includes $170 Million to Address Opiate Crisis and Behavioral Health Needs in the State
Tara Britton
Director of Public Policy
May 17, 2017

The Ohio House of Representatives passed its version of the state budget in early May and, as had been discussed for weeks, included a significant investment in behavioral health-related services to address the growing needs around the state’s opiate crisis and individuals living with mental illness. The funding totals $170.6 million over the biennium, spread across multiple agencies and initiatives. The funding is referred to as Ohio HOPES (Heroin, Opioids, Prevention, Education, Safety). The House shared that the funding is spread across four main areas: workforce, prevention, mental health, and treatment. More details around what is included in each of these categories is the focus of this blog.

In order to draw down federal dollars for Supplemental Nutrition Assistance Program (SNAP) employment and training programs (SNAP E&T), the House budget commits $2 million per year of state resources through the Job and Family Services (JFS) budget. SNAP E&T programs help SNAP recipients gain skills, training, and job experience. The House budget specifically directs the money to be used for programs that produce short-term non-degree certificates. In addition, the budget commits $5 million in 2019 to the Department of Higher Education. This money will also be used for short-term certificate programs associated with in-demand jobs. JFS and the Department of Higher Education are tasked with establishing a committee to develop a plan to draw down additional federal resources to support similar initiatives in the future.

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JMOC: Behavioral Health Redesign Update

By Brie Lusheck
Public Policy Associate
March 20, 2017

The Joint Medicaid Oversight Committee (JMOC) received testimony from two state directors who provided operational updates and policy changes for the state’s upcoming behavioral health redesign implementation on July 1, 2017. The directors touched on many of the changes the Department of Medicaid and the Department of Mental Health and Addiction Services have made since their last presentation before JMOC on behavioral health redesign in December.        

From the Ohio Department of Medicaid, Director Sears provided an update on the process behind modernizing the Medicaid codes for behavioral health redesign. Sears expressed that a long-term goal of the department is to provide data that displays Ohio’s overall behavioral health spending. Having this data will allow the state to better understand the services and supports needed for both physical and mental health care. This will be accomplished by comparing the new codes and making that comparison more transparent to better understand what services are being used. This will assist the state when setting future behavioral health goals.

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JMOC: Redesign Update and Panel Discussion
Loren Anthes, Fellow, Center for Medicaid Policy
June 3, 2016

The Joint Medicaid Oversight Committee (JMOC) had a lengthy discussion on May 26th regarding alcohol and drug addiction. During the meeting, which featured a panel of experts in the field, there were two main points of conversation. First, there was a “status update” by Dr. Mark Hurst, Medical Director of the Ohio Department of Mental Health & Addiction Services (ODMHAS), on the Behavioral Health Medicaid Redesign. Second, there were presentations from a number of guests representing providers and the county ADAMHS Boards.

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